Provider Demographics
NPI:1407846231
Name:BOOTH, MICHAEL EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BOOTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1087 MERIDIAN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4414
Mailing Address - Country:US
Mailing Address - Phone:830-237-6793
Mailing Address - Fax:830-387-5389
Practice Address - Street 1:160 CREEKSIDE WAY, STE. 602
Practice Address - Street 2:RESOLUTE FAMILY URGENT CARE
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-387-5330
Practice Address - Fax:830-387-5389
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXPA02135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical